Doctor Answers 168

Restylane or Juvederm ? Find a doctor you trust and work with them to find what is right for you

February 12th, 2009

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Both Juvederm and Restylane are FDA approved hyaluronic acid fillers. There are minor technical differences in the two products. Both are proven to provide lasting results. Having said that, I think an experienced physician can do just about anything with just about any product.

What is important to the consumer is what happens to a product when it is used by a less experienced physician. This is important because not everyone is going to be treated by the "world's greatest."

As a physician with a great deal of experience with these products, I prefer Restylane and Perlane. The "smoothness" of Juvederm is not a clinically meaningful expression. It is a marketing term of art. The marketing people are making lemonade out of lemons.

Having said that, when injecting tiny volumes, Juvederm is less likely to form a bump because it readily diffuses in the tissues. This is an advantage for doctors who are not prepared to mold and work with the filler once it is in the tissue.

Restylane is more cohesive and tends to stay where it is placed. It needs to be carefully molded once injected.

The advantage of this cohesion is that Restylane can be used to build up the face in away that is impossible with Juvederm. This is especially evident in the lower eyelid/tear trough hollow under the eyes. Juvederm injected in this area in enough volume to make a difference can readily drift into the top of the cheek creating unwanted fullness. This does not happen with Restylane.

On the other hand, one has to expect lumps with Restylane and actively work to smooth these if they occur. This can easily be done and it is my opinion that the results are worth the effort.

Some authors here suggest that Juvederm does not last, and I think the reality is that it does last but it tends to get flattened in the tissue and over time appears less effective.

Recognize that some offices push products because the doctors get financial incentives from the companies to do so and these incentives increase based on how much of the company's product the offices uses.

For example, Allergan incentivizes plastic surgeons by counting any of the Allergan products, this includes BOTOX, Juvederm, Prevage, as well as Allergan manufactured breast implants. For Allergan, the offices that use enough of their product not only get a significant discount on product, they get favorable placement on the Allergan doctor referral website.

Medicis, the company that makes Restylane, has a similar type program, but it only applied to its hyaluronic acid filler products. So be aware of this because it creates a potential bias in what the doctor may recommend.

Ultimately it comes down to trust. Do you trust the doctor to make a recommendation that is right for you and not the doctor's wallet?

Juvederm vs. Restylane - Hyaluronic acid product comparison

Each product has its pros and cons. However, my personal experience has caused me to use Juvederm much more than Restylane.

Similarities:

Both products are safe and effective.

They cost about the same.

They are both made of hyaluronic acid, which is a normal component of your skin's matrix. That is why, unlike some other collagen based products, allergy testing is not needed. Because of this you can be treated on the same day as your consultation.

Both products tend to be smooth and plane out after injection.

Key Differences:

Although Restylane typically lasts 6-9 months, Juvederm often lasts 9-12 months and has FDA labeling saying that it "may last up to 12 months."

Microscopically, Juvederm is a smoother compound than Restylane, although I am not sure that it behaves much differently in patients.

Juvederm has a higher concentration of the active product, hyaluronic acid.

A treatment session with Juvederm uses a complete syringe (it can't be shared or stored for later use). Restylane is offered in both 0.4cc and 1.0cc sizes, so you have the ability to purchase a smaller syringe at a lower cost if you have a low volume issue requiring correction.

Also, Restylane syringes typically have 1.2 or 1.3cc while Juvederm has 1.0 or 1.1cc. So, you get more physical product with Restylane than Juvederm.

The reason that I use Juvederm more is that I feel it does settle in smoother. My patients agree on this fact.

I also believe Juvederm lasts a little bit longer than Restylane.

Finally, the design of the syringe makes it easier to inject, increasing the precision of the injections.

Juvederm and Restylane are both hyluronic acid fillers...

August 10th, 2008

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Juvederm and Restylane are both hyluronic acid fillers and are competitors of each other. In experienced hands, we can get very nice results with each, but it all depends on the specific area being treated. For example:

I use Juvederm for lips and for nasolabial folds because I feel it is softer and a bit more hydrophilic (attracts fluid to the area) so it tends to provide a very smooth result.

However, this extra bit of swelling is not as helpful around the eyes, so I use Restylane for the tear troughs (area underneath the lower eyelids).

For very fine lines, I will use a newer product called Prevelle Silk, which is also a hylauronic acid filler, but not as thick as Juvederm or Restylane.

Finally, for deeper wrinkles or to add volume to the cheeks, I will use Radiesse, which provides excellent results in this area.

So, it's important for your doctor to really listen to what your areas of concern are, and then pick the right product to treat those specific areas.

Juvederm Pictures

What matters most is the Juvederm or Restylane injector

April 21st, 2010

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The most important point in choosing a filler is the skill and artistry of the injector. There are some difference between the fillers in terms of their consistency, the syringes that are supplied and how they are manufactured. Some patients and practitioners do have preferences of one over the other. But these differences pale in comparison to how they are used.

Another important consideration is the amount of product that is used. Understandably, people want to use the least amount of product as the procedure is costly. However, I have become a huge advocate of "full correction". This means that you need to replace enough of the lost volume to get a great result and not just fill in the line with a liitle bit of product to get a good result.

I performed a study that showed that 6-8 syringes of product resulted in patients looking on average 7 years younger! This was recently published in the Journal of Dermatologic Surgery. I try to explain that although the fillers are temporary, they don't go COMPLETELY away that quickly. So ideally our patients/clients will come back at 6-10 months and get a retreatment that is usually 1/2 to 1/3 of the amount done originally. If you keep these "maintenance" treatments up, then you can retain the youthfulness that these injections impart for years.

Restylane vs Juvederm for full lips and wrinkle elimination

November 16th, 2008

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Restylane and Perlane are naturally-occurring injectable agents used for lip enhancement and to soften facial lines and creases. We have found Restylane, Perlane, Juvederm Ultra, and Juvederm Ultra Plus to be very well tolerated, and have yet to encounter an allergic or inflammatory response to any of these products. According to our Allergan representative, our Raleigh, North Carolina Plastic Surgery Practice is one of the top users of Juvederm in the U.S., but we do still use Restylane and Perlane for some patients and we feel confident in the safety and efficacy of both Restylane and Juvederm products.
Restylane and Juvederm do NOT contain any material that does not naturally occur in soft tissues, such as hydroxyapetite or methylmethacrylate, which can result in granuloma (cyst) formation and chronic inflammation. Be VERY wary of injectable agents that contain materials that do not naturally occur in soft tissues, as the risk of these complications is often minimized to patients.
Restylane or Juvederm injections require just a few minutes to perform. The aesthetic improvement is immediate, and in general we will attempt to slightly overfill the lips and overcorrect lines and folds, so that the desired effect remains once the mild initial swelling subsides (in about 24 hours). The goal is an aesthetic improvement that appears natural. We use a newer hyaluronic acid filler, Prevelle Silk ,for people who cannot tolerate any downtime whatsoever.
Most injections of Juvederm Ultra or Juvederm Ultra Plus, Restylane or Perlane can be performed with little or no pain by administration of local anesthesia just prior to the injection. Injection of the lips is usually completely painless, using intra-oral anesthesia that produces total numbness of the lips. For injection of lines and creases on the face, a local anesthetic solution is used that causes vasoconstriction, decreasing the likelihood of bruising following the injection. Our aim is to provide an immediate and beautiful aesthetic enhancement, with little or no discomfort and downtime.
The duration of the improvement varies from patient to patient. Some patients have reported ressults of up to a year with Juvederm Untra Plus. Many patients that enjoy the results of their hyaluronic acid treatments become interested in permanent soft tissue enhancement. For these patients, structural fat grafting, using autologous (the patient's own) fat. Using specialized instrumentation and technique, structural fat grafting can produce permanent improvements in facial contours.
When performed with expertise by an exerienced injector, the results of Juvederm, Restylane, Perlane. Prevelle Silk or fat grafting can look and feel natural. For best results, look for a board certified plastic surgeon or dermatologist with years of experience with a variety of dermal fillers. Be sure to view many before and after photographs. In most offices, many staff members have received dermal fillers in their lips or other areas of the face and would be pleased to share their experience with you.

Which is better - Juvederm or Restylane?

May 6th, 2008

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There is no one product that is better or worse here, but I can say that Juvederm is a little more expensive than Restylane, so until the syringes of Juvederm contain the same amount of Restylane (they contain 27% less filler than Restylane syringes), I will use more Restylane.

As a board certified dermatologist, I like both products and actually did the studies for Perlane, a new form of the Restylane product that is used for filling large wrinkles. Juvederm seems to go in a little bit more smoothly and is not as likely to be lumpy. On the other hand, however, it doesn't seem to provide the lift that Restylane and Perlane provide.

The best thing to do is to try them both! I frequently will use both for patients that ask and let them decide.

Restylane is better than Juvederm

April 24th, 2008

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They are both very good products. I find that Restylane is more dependable than Juvederm. I have used both in the lower eyelid. Restylane behaves itself there. I have had two cases with Juvederm where the patients looked fine and "under corrected" when they left my office, only to have excessive swelling a few days later.

Likewise, the only time that it was necessary to decrease the size of lips was after a very small amount of Juvederm was injected in a high profile patient. Fortunately, after Widase injections the lips were corrected.

I have had many patients who did fine with Juvederm, but the risk of excess swelling in that occasional patient has me using Restylane more often. My experience is that when I use equal amounts of the products, Restylane lasts longer.

Juvederm and Restylane are very similar products.

Currently we have 4 major FDA approved hyaluronic acid fillers on the market:

Restylane

Perlane

Juvederm Ultra

Juvederm Ultra Plus

Restylane and Perlane are produced by Medicis. They are similar products, but Perlane has bigger size particles, and is better for correction of deeper, larger troughs, for example deep, wide nasolabial folds.

Juvederm Ultra and Ultra Plus come from Allergan. Juvederm Ultra is similar to Restylane, and Juvederm Ultra Plus is similar to Perlane, with larger size particle, need for deeper injection, and suitability for larger size defect correction.

As far as the difference between Restylane and Juvederm is concerned, I tell my patients that it is similar to the one between Coke and Pepsi - mostly depends on the personal preference. There is slightly more of a spread effect from Juvederm, and slightly more localized volume correction from Restylane, but the difference most of the time is minimal. They last about the same, and the cost in our clinic is the same.

While it is common to hear that Restylane causes more lumps, I believe it is more dependent upon the injector. If you have a good, experienced injector, you will do great with Restylane in the lips. We have been doing it for years.

Restylane vs Juvederm? Similiar yet different

Good question, but the answer can be very technical or as simple as the injectors preference. There are a lot of repetitive answers below but some technical information is missing.

The value or longevity of a Hyaluronic Acid filler (HA) is determined by the amount of cross-linking of the gel molecules. The body is very effective at removing things that do not belong. The beauty of HA is that it is also produced in the body so that it can stay because it is not a completely foreign object.

Collagen that used to be injected was from cow hide so that it was rapidly identified and then broken down by the body. It also required a test to determine if you had an allergy. HA is not broken down by this pathway, it is broken down other ways. The more solidly (or crosslinked) an HA product is the longer it will last. The absolute amount of HA in a syringe does not translate into more product remaining in an injected area. ONLY the crosslinked amount of HA in the syringe will actually remain.

The non-crosslinked product will be dissolved in a few days. The non-crosslinked HA is smoother and allows for easier injection and some controllability in some hands but will NOT contribute to longevity. Restylane is a higher concentration of cross-linked molecules of HA than Juvederm.

So Restylane is stiffer, requires more skill to inject correctly, more skill to place correctly and will last longer. In some areas these are desirable consequences like the nasolabial folds.

Juvederm is softer and easier to inject and feels different so it is better in the lips but it will go away faster. So I use both products every day in different areas and in some patients, I will use both products depending on the patient's desires and concerns.

Juvederm is probably better

October 30th, 2008

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Restylane is a bit clumpy compared to Juvederm and harder to sculpt precisely. Restylane seems to have more bruising as well. Each seems to last about 6 months. The two companies are dueling with who lasts longer, each getting longer FDA permissions to say which lasts longer.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.